血型免疫性抗体引起新生儿溶血病的血型血清学结果分析

Analysis of blood group serological results of neonatal hemolytic disease caused by blood group immune antibodies

目的:回顾性分析由血型免疫性抗体引起的新生儿溶血病(hemolytic disease of the newborn, HDN)在新生儿高胆红素血症诊断中的意义。方法:将2018—2021年接检的3 922例新生儿高胆红素血症患儿作为对象,对其样本进行血型鉴定和溶血三项试验的检测并分析试验结果。结果:从3 922例样本中检出HDN患儿阳性病例827例,检出率21.09%。其中ABO-HDN占98.55%(815/827);Rh-HDN占1.45%(12/827)。815例ABO-HDN患儿中A型占60.74%(495/815);放散试验阳性率100.00%;游离试验阳性率73.99%;直接抗人球蛋白试验阳性率11.17%。12例Rh-HDN中产妇为RhD阴性占83.33%(10/12);放散、游离、直接抗人球蛋白试验均为阳性,检出率100.00%。结论:在HDN诊断中以放散试验最为敏感,具有指导诊断性意义;ABO-HDN中以A型胎儿出现溶血的最为多见,Rh-HDN中以RhD阳性胎儿出现溶血的最为多见;所以产前积极预防和产后尽早送检有助于减少溶血给新生儿带来不可逆的危害。

Objective To retrospectively analyze the significance of hemolytic disease of the newborn(HDN) caused by blood group immune antibodies in the diagnosis of neonatal hyperbilirubinemia.Methods A total of 3 922 neonates with neonatal hyperbilirubinemia who were examined in our department from 2018 to 2021 were selected as the analysis objects. Blood typing and hemolysis tests were performed on their samples and the test results were analyzed.Results Among 3 922 samples, 827 cases were positive, with a detection rate of 21.09%. ABO blood-HDN accounted for 98.55%(815/827). Rh-HDN accounted for 1.45%(12/827). Among 815 ABO-HDN patients, 60.74%(495/815) were type A. The positive detection rate of dispersion test was 100.00%. The detection rate of free test was 73.99%. The detection rate of direct resistance test was 11.17%. Among the 12 cases of Rh-HDN, 83.33%(10/12) were RhD negative. The detection rate of dispersive, free and direct antibody tests was 100.00%.Conclusion In the diagnosis of HDN, the diffusion test is the most sensitive and has guiding diagnostic significance. In ABO-HDN, hemolysis was most common in type A fetuses, and in Rh-HDN, hemolysis was most common in RhD positive fetuses. So prenatal active prevention and postpartum as early as possible would help reduce hemolysis to neonatal irreversible harm.